Anatomical variations of the celiac trunk in adult Filipino cadavers: A retrospective study

Objectives@#The celiac trunk (CT) is the first major branch of the abdominal aorta and typically gives rise to the left gastric artery (LGA), common hepatic artery (CHA), and splenic artery (SA), which supply blood to the abdominal viscera. Variations in the branching pattern of the CT exist and knowledge of such is crucial when performing surgical, laparoscopic, and angiographic procedures. The aim of this study is to determine the anatomic variations of the CT in adult Filipino cadavers and to compare the proportions of these with those reported in the foreign literature.@*Methods@#Adult Filipino cadavers from the University of the Philippines College of Medicine Anatomy Laboratory were dissected by first year medical students from 2014-2019. The CT and its branches were identified, drawn on a separate piece of paper, and confirmed to be correct and accurate by an anatomist. The data collected from that period was reviewed. Percentages were calculated for the branching patterns identified. A Z-test of Two Populations was used to compare the results of the current study to that of Pinal-Garcia (2018), Pillay (2020) and Venieratos (2013).@*Results@#A total of 107 drawings based on 107 dissected preserved cadavers were reviewed. Ninety-two specimens (85.98%) showed typical branching into the LGA, CHA, and SA. The CT presented as a true tripod (tripus Halleri) in 75 specimens (70.09%) and as a bifurcation with one of the three arteries arising first along the trunk (false tripod) in 17 specimens (15.89%). Nine cadavers (8.41%) showed additional branches arising from the CT and four (3.74%) showed bifurcation of the CT with the third branch arising from a different artery.@*Conclusion@#The most common configuration of the CT among Filipino adult cadavers is a true tripod, followed by a false tripod, additional branching, and bifurcation of the CT with the third branch arising elsewhere. The present study most closely resembles the results of the study of Venieratos.

Student evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 pandemic: A retrospective study

Background and Objective@#The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. @*Methods@#This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students’ reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. @*Results@#One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating ‘5’ or a ‘Strongly Agree’ to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. @*Conclusion@#The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.

Peripheral brain access in small group discussion in anatomy

Background and Objective@#The pandemic has forced medical education to adopt online and hybrid set-ups, and this has greatly changed the way human anatomy is taught. Course-required knowledge can be accessed using raw references like original publications, collected reviews such as those found in books, as well as in shorter versions like summaries, and in online or electronic applications or software. With readily accessible online physical materials and human resources in anatomy, the value of learning by seeking out verifiable information to answer a real time query may change the current method of teaching and assessment of outcome-based learning in a heavy-recall subject such as human anatomy. For the student, sources of information or instruction are termed the “peripheral brain”. The objective of this study is to describe the medical students’ method in accessing medical information during a hybrid small group discussion.@*Methods@#In a modified hybrid laboratory set-up, a class of 200 students were divided into 18 groups, with two students in each group acting as laboratory dissector, who will broadcast their in-person classroom activities to the group members via zoom. The groups rotated in nine specimen stations consisting of soft-embalmed cadavers, plastinated specimen, models, bones, and VH dissector™ virtual dissector. Students were allowed to use any type of resources to accomplish the following tasks: 1) look for listed structures, 2) identify landmarks, and 3) describe functions. A Google sheet survey was administered a month after the activity on the following domains: search strategy, targeted references, and verifiability of information. @*Results@#There were 110 students with age range of 19-27 years old, who participated in the study. Their most accessed reference is still personally prepared notes, followed by electronic books. When using ebooks, the first thing students reported exploring is the table of contents, followed by the search button. If doing online search, the key word used is the structure or function of interest. In group dynamics, students prefer to divide the work and assign tasks to each member, instead of collectively and simultaneously discussing a topic. For them, the most important characteristic of a reliable peripheral brain is that it is the recommended reference, followed by how current the reference is, i.e., published in the last 3 to 5 years. Interestingly, for most students, the information must be acquired in 5 minutes, which is contrary to the preferred mode of reference. Artificial intelligence may enhance SGDs according to most of the students. In accessing peripheral brain, Google is perceived as the quickest, books are most reliable, and Pubmed is the most up-to-date. Most of the students preferred pre-assigned questions or tasks during SGDs, with equal distribution of work. Giving and receiving remote instructions is not a problem. Dealing with a difficult group member is important, but is not a problem in hybrid discussion. @*Conclusion@#The survey results provide valuable insight on learning strategies used by the current generation of medical students, who have started medical school during the pandemic and are used to online teachinglearning modes of instruction. These findings can be exploited in designing course activities. The concept of peripheral brain in small group discussions can be formally introduced to students learning anatomy to utilize modern technology in enhancing knowledge.

Task-oriented learning in head and neck anatomy using virtual, formalin-preserved, soft-embalmed, and plastinated cadavers

Background and Objective@#The COVID 19 pandemic has changed the way the human anatomy is taught. A necessary shift towards online instruction, combined with a decrease in cadaver donation has resulted in the need for maximizing formalinized, soft-embalmed, computerized, and plastinated cadaver specimens. Task-oriented activities allow students to demonstrate acquired knowledge and skills. It is the aim of this study to get the perspective of students in the utilization of available laboratory materials.@*Methods@#One hundred forty-three students participated in task-oriented activities. Students demonstrated anatomy of the facial nerve, recurrent laryngeal nerve, and phrenic nerve by parotidectomy, thyroidectomy, and posterior neck dissection using formalinized cadaver and VH dissector™. Deep neck and sagittal structures in the plastinated specimen were identified using laser pointers. Ossicular mobility of the middle ear, and endoscopy of the nose and larynx were demonstrated using the soft embalmed cadaver. Students were surveyed on their perceptions on the utility of each cadaver specimen.@*Results@#Formalinized and soft-embalmed cadaver were observed to present the most accurate anatomy, while the virtual dissector and plastinated specimens were seen to be the most sustainable and reusable. @*Conclusion@#Task-oriented learning in head and neck anatomy may use different cadaveric materials with varied accuracy and utility.

Anatomical variations of the Celiac trunk in adult Filipino cadavers: A retrospective study

Objectives@#The celiac trunk (CT) is the first major branch of the abdominal aorta and typically gives rise to the left gastric artery (LGA), common hepatic artery (CHA), and splenic artery (SA), which supply blood to the abdominal viscera. Variations in the branching pattern of the CT exist and knowledge of such is crucial when performing surgical, laparoscopic, and angiographic procedures. The aim of this study is to determine the anatomic variations of the CT in adult Filipino cadavers and to compare the proportions of these with those reported in the foreign literature. @*Methods@#Adult Filipino cadavers from the University of the Philippines College of Medicine Anatomy Laboratory were dissected by first year medical students from 2014-2019. The CT and its branches were identified, drawn on a separate piece of paper, and confirmed to be correct and accurate by an anatomist. The data collected from that period was reviewed. Percentages were calculated for the branching patterns identified. A Z-test of Two Populations was used to compare the results of the current study to that of Pinal-Garcia (2018), Pillay (2020) and Venieratos (2013). @*Results@#A total of 107 drawings based on 107 dissected preserved cadavers were reviewed. Ninety-two specimens (85.98%) showed typical branching into the LGA, CHA, and SA. The CT presented as a true tripod (tripus Halleri) in 75 specimens (70.09%) and as a bifurcation with one of the three arteries arising first along the trunk (false tripod) in 17 specimens (15.89%). Nine cadavers (8.41%) showed additional branches arising from the CT and four (3.74%) showed bifurcation of the CT with the third branch arising from a different artery. @*Conclusion@#The most common configuration of the CT among Filipino adult cadavers is a true tripod, followed by a false tripod, additional branching, and bifurcation of the CT with the third branch arising elsewhere. The present study most closely resembles the results of the study of Venieratos.

Disability weight determination for road traffic injuries in the Philippines: Metro Manila scenario

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the Disability Adjusted Life Year (DALY) weights of road traffic injuries and use the DALY weights in determining the total DALYs lost in Metro Manila using available data.</p><p style="text-align: justify;"><strong>Methods:</strong> Consensus on DALY weights for each of the 31 International Classification of Diseases (ICD)10 codes related to road traffic injuries was done using Delphi Process. Experts from different fields were invited to participate in 2 rounds of discussion-and-scoring were done to obtain consensus were obtained for each DALY weight. Philippine Health Insurance Corporation (PHIC) data on the counts of the 31 ICD 10 coded claims for the years 2011, 2012, and 2013 were obtained and used to calculate the total DALY lost due to vehicular injuries for Metro-Manila.</p><p style="text-align: justify;"><strong>Results:</strong> Road traffic related injuries affected mostly young people (mean 34 yo + 15) and affected mostly men (81%). There were a total of 3,199 injuries seen in 2,573 patients. 98.1% of the patients had a < 1 year type of injury with an average disability weight of 0.34154 and a total DALYs lost of 300.4. 0.5% of the patients had a ? 1 year type of injury with an average disability weight of 0.2726 and a total DALYs lost of 218.08.1.4% of the patients most likely died from their injuries earning a total DALYs lost of 1,440.The sum of DALYs lost is equivalent to a total of 1,958.12.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The Metro Manila loses roughly Php 76.6 Million per year due to road traffic injuries and accidents. These events are highly preventable. Without proper interventions, road traffic injuries may lead to impoverishment of the young families who pick up the pieces, or are left behind.</p>

The recurrent laryngeal nerve in relation to the inferior thyroid artery in adult Filipino cadavers

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Descriptive, cross-sectional<br /><strong>Setting</strong>: University of the Philippines College of Medicine Anatomy Laboratory<br /><strong>Subjects</strong>: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into two variations: non-branching or branching prior to insertion at the cricothyroid joint under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions.<br /><br /><strong>RESULTS</strong>: Fifty four (54) cadavers (108 sides) were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches.<br /><br /><strong>CONCLUSION</strong>: There are multiple anatomical variations regarding the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon's knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.</p>